SUMMARY

• Over seven (7) years of experience in the IT industry for different business - productivity as Business Analyst and Business Systems Analyst in healthcare.
• Worked with current industry standards, such as HIPAA, SOX, ISO, Six Sigma, and Capability Maturity Model (CMM).
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837, 835, 834, 820, 270, 271, 276, 277.
• Well versed with ICD9, ICD 10, CPT and HIPAA.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI).
• Strong understanding of EMR (Electronic Medical Records), EHR (Electronic Health Record) and PPACA.
• Experienced in working with various software development life cycles, such as, waterfall, Agile/Scrum, and RUP (Rational Unified Process).
• Strong understanding in Medicare and Medicaid
• Extensive experience in gathering Business and Functional Requirements, Business Scope & Vision Document, developing Business Requirement document, Functional specification document, communication plan, Use Cases, conducting Gap Analysis and Risk Analysis.
• Experienced in conducting JAD sessions and Interviews, adept in implementing requirements, creating project status reports and presentations.
• Extensive knowledge of Facets Data Model
• Expertise in creating and executing Test plans, Test scripts, Test cases, for Manual and automated testing.
• Experience creating Traceability matrix to better manage the requirement gathering process and keeping track of the milestones.
• Highly motivated, creative and illustrated positive and productive team environments with integrative thinking skills which was used to problem solving and making sound decisions.
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.

TECHNICAL SKILLS

Operating Systems: Linux, HP UNIX, Sun Solaris, and Windows 2000/XP/Vista

Languages: C, C++, SQL, PL/SQL, JAVA, .Net.

Packages: MS Office, MS Visio, MS Project

Tools: Clear case, Clear Quest, Rational Rose, Requisite Pro, HP Quality Center

Databases: SQL, Oracle, MS Access, SQL Server 2000

Methodologies: Rational Unified Process (RUP), Software Development Life Cycle (SDLC), Waterfall, Agile

Others: Trizetto Facets 4.x, MS Office (Word, Excel, Power point), MS Project, Fox Pro., Tally 7.2., TOAD

PROFESSIONAL EXPERIENCE

Confidential, Raleigh, NC

Business Analyst

Responsibilities:

• Involved for conducting requirement sessions directly with end users and network groups to capture all variations of care management workflows.
• Gathered business and functional requirements for new, upgraded care management system flexible for variety of end users to identify and document business needs and objectives, current operational procedures, problems, input and output requirements, data scope, usage, formatting and security requirements.
• Learned the Agile methodology for the project, Wrote and maintained functional specifications through “user stories” for new or modified business systems.
• Guided the team to document epic and stories and requirement maintenance using tools like JIRA and Confluence.
• Prototyped web pages and reports to review by 6 clinical network directors/stakeholders and developers.
• Consulted with systems analysts and programmers to design and develop business systems based on the UI team requirements.
• Assisted in testing, verification and deployment of the clinical system of the project.
• Prepared time and cost estimates for completing projects with scrum masters and project manager.
• Received multiple appreciation from the management and network groups over short period of time for documenting and developing core care management workflows.

Confidential, Durham, NC

Business Analyst

Responsibilities:

• Gathered Requirements and created Software Requirement Specifications (SRS), and Functional Specification Document (FSD) documents using Caliber RM
• Scheduled meeting with developers, SA’s (System’s Analyst) and testers to collaborate resource allocation and project completion using MS Project.
• Created Functional Design Documents for the 837 Claims, 835 Claims Payment/Advice & NCPDP Drug Transactions for the implementation of the Trizetto Facets System.
• Proactively managed Software development, Requirements Analysis & Design, RFP/ RFI creation using Rational Rose and Requisite Pro.
• Performed gap analysis of NCPDP Drug transactions for the conversion of the Drug transactions to 837 transactions and Loading them to Facets System.
• Used Data mapping for collecting the data.
• Configured Trizetto’s HIPAA Gateway for Batch & Real time transactions.
• Experience creating design documentation related to system specifications including user interfaces, security and control, performance requirements and data conversion.
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Developed test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
• Worked closely with the architects, database administrators and technical team during Data Mapping and Data Integration.
• Involved in the strategic business planning, infrastructure plans, and re-engineering business functions of the hospital
• Developed Class Diagrams, State diagrams and physical Component diagrams/DFD’s to capture the entire system functionality and thereafter built a framework for functioning
• Utilized business and technical tools to develop business, financial, and system requirements analyses with supporting variance reports

Environment: Microsoft Office Suite, Facets 4.71, RUP, UML, SQL,MS-Office, MS Project, MS Visio, Test Director, HTML, DHTML, Oracle

Confidential, Pittsburgh, PA

Business Analyst

Responsibilities:

• Involved in the analysis of the Business Requirements Document (BRD) and providing the technical response.
• Analyzed the impact of ICD-10-CM/PCS coding system and Identified General Equivalence Mappings to facilitate the conversion from ICD-9-CM codes to ICD-10-CM/PCS codes to ensure that both the application and Health Record comply with new regulations.
• Conducted an impact analysis for the Facets upgrade.
• Interviewing area experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical people.
• Created End-to-End Business process flow for Membership, Enrollment and Billing (EDI 834, 820, 837).
• Created as-is and To-Be flow and identified area of improvement.
• Created Functional Design Documents (FDD) for new extensions and interfaces.
• Designed Report Design Documents (RDD) for new reports.
• In depth analysis of Facets Data model and data mapping.
• Responsible for keeping data in the lookup table, for Individual enrollment, up to date as per the Business Requirements.
• Worked very closely with Business, Development team, Testing team and release management team.
• Involved in JAD sessions with the other departments.
• Involved in post production support and troubleshooting.
• Worked as a User\Customer Advocate and negotiated with user as well as with developers and management staff to resolve any requirement conflict to bridge the gaps between IT and Business client

Environment: Trizetto Facets 4.41/ 4.71, MS Visio, MS Word, MS Excel, SQL Advantage, Rational Clear Quest

Confidential, Baton Rouge, LA

Business Analyst

Responsibilities:

• Responsible for the fullHIPAAcompliance lifecycle fromgap analysis, mapping, implementation and testing for Medicaid Claims.
• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Responsible forMedicaid ClaimsResolution/Reimbursement for state health plans usingMMIS.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.

Environment: MS Project, Rational tools, MS Word, SharePoint, Visio, SQL, and MS Excel.

Confidential, Virginia Beach, VA

Business Analyst/Data Analyst

Responsibilities:

• Created process flows for HIPAA EDI transactions such as 270, 271, 276, 277 and 820.
• Played an active and lead role in gathering, analyzing, and writing business requirements.
• Involved in Requirement Scoping and analysis of high priority requirements for implementation.
• Designed the business requirement collection approach based on the business need and requirement priority.
• Conducted end user surveys and interviews to come up all the relevant fields and information required.
• Conducted JAD workshops to achieve consensus on critical and sensitive issues and members privacy requirements.
• Consulted with legal SMEs to ensure compliance with state medical privacy laws.
• Actively involved in the creation of comprehensive resource center through collection, documentation and extensive editing of relevant medical literature.
• Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
• Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval.
• Suggested changes when the user interface was confusing or needed rewording.
• Authored Companion Guide to support all the information needed to process HIPAA transactions with Confidential .
• Prepared user acceptance criterion and testing strategy that will be utilized by QA team to validate the addressed functionality of all critical requirements.
• Developed and maintained Test Matrix and Traceability Matrix. Utilized Quality Center to plan and execute tests, track defects and create change alerts.
• Conducted User Acceptance Testing (UAT).

Environment: HIPAA ANSI X12, Rational Rose, Rational Requisite Pro, Microsoft Visio, SAS, Java, MS word, MS Excel, MS outlook, MS Access, EDI, Oracle, MS SQL Server.

Confidential, Philadelphia, PA

Business Systems Analyst

Responsibilities:

• Responsible for defining the scope of the project, gathering business requirements, doing gap analysis and documentation.
• Articulated business requirements from user interviews and then converted requirements into technical specifications
• Developed data validation program for HIPAA transactions
• Created the as-is and to-be process flow diagrams based on the current system features and the stakeholder’s needs.
• Designed Connection Models for Validation and transformation of HIPAA transactions using EDI Source and HIPAA Model.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped..
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using Requisite Pro, Rational Rose and MS Visio.
• Worked with technical experts to prepare test case scenarios for unit testing, integration testing, user acceptance testing and compliance testing.
• Developed ETL logic to transfer data from systems to the Data warehouse environment using the available ETL code and tool set for implementation.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Provided SME support to the development and testing teams.

Environment: SQL Server, Rational Suite tools, MS Visio, MS Project, MS Office (MS Word, MS Excel, MS PowerPoint), MS Access.